Treatment of high blood pressure in seniors

It is not uncommon that the decision to use antihypertensive therapy in aged seniors (>80 years) represents a dilemma. How much can be achieved for the patient without causing any damage? The benefit of antihypertensive treatment also for older seniors is nowadays proven without any doubt: stroke rate, decompensation of heart insufficiency and coronary heart disease (CHD) events are reduced. Pharmaceutical treatment may be implemented above a systolic blood pressure of 140 mm Hg. The treatment target should be a systolic value between 130 and 135 mm Hg. Lower systolic target values (120–125 mm Hg) cannot be generally recommended. Diastolic blood pressure values below 65 mm Hg should be avoided. The individualization of treatment with careful selection of patients, cautious performance of treatment and attentive monitoring of the course of side effects are essential. This includes in particular hypokalemia and hyponatremia, orthostatic dysregulation and deterioration of renal function. Principally, all antihypertensive agents of the five main substance classes can be administered. Diuretics (long duration) and calcium channel blockers can be preferentially recommended as well as angiotensin-converting enzyme (ACE) inhibitors and if necessary angiotensin II receptor subtype 1 (AT1) blockers. © 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.